Your Digest for Thursday, Mar 07, 2024 04:59 PM


Pompholyx

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Dishydrotic eczema
Precipitated by sweat - in high humidity conditions.
pruritic (intensely)
Small blisters
Management


Diagnosis of Diabetes mellitus

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[!TIP]Mnemonic: Seven - eleven
DiabetesSevenElevenMnemonic.png
HbA1C > 6.5% is diagnosis of DM.

HbA1C should be avoided in pregnancy, children, haemoglobinopathies, haemolytic anaemia, HIV, untreated iron deficiency anaemia. (due to high turnover)
Abnormally low HbA1c can be caused by deteriorating renal function and weight loss.


Types of Thyroiditis

Thyroiditis typically causes a painful goiter.

Hashimoto thyroiditis (chronic autoimmune thyroiditis)

hashimotosThyroiditis.png

Post partum thyroiditis.


📑Azathioprine


- Or with a *differentiating agent*. (**All trans retinoic acid**)
- has the t(15:17) translocation.

Background physiology of lymphocytes

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Source-YouTube
Source-YouTube
Source-YouTube

MHC I MHC II
Present on ALL nucleated cells Presenton APCs
Binds CD8 receptor Binds CD4 receptors
Stimultes Cytotoxic T cells Stimulates T helper cells

Natural killer cells

[!TIP] 2 minute summary: from MSD manuals
Chronic myeloid leukemia (CML) occurs when a pluripotent stem cell undergoes malignant transformation and clonal myeloproliferation, leading to a striking overproduction of mature and immature granulocytes. Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding, fever, lymphadenopathy, and skin changes. Peripheral blood smear, bone marrow aspirate, and demonstration of the Philadelphia chromosome are diagnostic. Treatment is with tyrosine kinase inhibitors (TKI) such as imatinib, dasatinib, nilotinib, bosutinib, and ponatinib, which significantly improve response and prolong survival. Myelosuppressive drugs (eg, hydroxyurea), stem cell transplantation, and interferon alfa are also sometimes used.

| Polycythemia | ❗Anaemia - may be symptomatic | |
| | Lymphadenopathy - only in blast crisis | |
| ❗Trilineage hypercellularity | Bone marrow : increased cellularity | |
| Mx : Aspirin and phlebotomy | TKI - b / intenstive chemotherapy like AML if blast phase occurs | |

Chronic lymphocytic leukemia features

[!INFO] 2 minute summary from MSD manuals.
Chronic lymphocytic leukemia (CLL) is characterized by progressive accumulation of phenotypically mature malignant B lymphocytes. Primary sites of disease include peripheral blood, bone marrow, spleen, and lymph nodes. Symptoms and signs may be absent or may include lymphadenopathy, splenomegaly, hepatomegaly, fatigue, fevers, night sweats, unintentional weight loss, and early satiety. Diagnosis is by flow cytometry and immunophenotyping of peripheral blood. Treatment is delayed until symptoms develop and generally involves chemotherapy and immunotherapy. However, treatments are evolving, and first-line regimens may include targeted agents such as inhibitors of Bruton tyrosine kinase (Btk) and Bcl-2, with or without chemotherapy. CLL is considered incurable with current treatment.


Protozoan parasite.

The center of the spectrum consists of localized cutaneous leishmaniasis (LCL), which is the most common clinical presentation.
At the opposite end of the spectrum, diffuse cutaneous leishmaniasis (DCL) is caused by polyparasitic disease with a predominance of parasitized macrophages and no granulomatous inflammation.
This is the commonest form in Sri Lanka. Source
CutaneousLeishmaniaisSriLanka.png
CutaneousLeishmaniasis.png


Follicular cells give rise to Papillary, follicular and anaplastic CA.
Parafollicular C cells -> Medullary CA. (C cells are neuroendocrine cells and they produce [[Hormone Physiology#Calcitonin|Calcitonin]]).

Most cold nodules are due to benign processes (>90%)
Cold nodules have an approximately 5% risk of being cancerous.
--- simplified to--->

[!TIP] mnenonic: hurthel - turtle
Turtle cells have polygonal markings -> polygonal cells seen on histology
hurthlecellMnemonic.png

Hürthle cell carcinoma is a rare, more agrressive variant of follicular carcinoma. 5 year survival is 50 - 60%.
Composed of distinct looking polygonal cells with acidophillic cytoplasm.
thyroidCAanaplasticMedullaryMnemonic.png
So much so that there is a clinical distinction between identification of patients with familial MTC and diagnosis a new sporadic MTC.
RET proto-oncogene mutations are seen in all MTC syndromes.

Approximately 80% of individuals with a RET genetic variant will develop medullary thyroid cancer at some point in their lives.

In treatment of MEN, to avoid intra op hypertension, resection of pheochromocytoma should be done before MTC resection.
පර පා පි
පර මේ ෆි
මා මේ ෆි
[!TIP] Mnemonic: A for anaplastic and abyssmal
Occurs in older adults (60-70) -> older adult with a thyroid nodule could have a dangerous thyroid CA.
1 year survival is a dismal 20%. Median survival is 5-6 months.



Mnemonic for HLA types and associations

HLA-A3:
3 looks like E.
AE - haemochromatosis

HLA-B51 - (B52 was a bomber in WW2)
behcetsHLAB51Mnemonic.png
diseases beging with B.
Behcet's disease

HLA-B27 - B 2 -> b is the second letter, A is the first leter.
All A's
Anki spondi
Arthrits - reactive and psoriatic
Anterior uveitis

HLA-DR2 (DR - doctor) 2 for two disease
Goodpasture
narcolepsy
(Good doctor is sleeping)

HLA-DR3 (3 looks like E)
Dry Eyes - Sjogrens - And everything starts with an S
Snakes - dermatitis herpetiformis (herpetologist - "herpet" means to do with snakes)
PBC - Seerrhosis

HLA-DR4
T1DM
Rheuamtoid arthritis (4 looks like A - RA -arthritis)

Glaucoma

Source Youtube
Managementof AACG - acetazolamid 500mg stat followed by pilocarpine
POAG - primary open angle glaucoma - associated with myopia (long eye ball) and not hypermetropia (short eye ball) like AACG.
Cup : Disk ratio > 0.7 is seen.
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